Provider Demographics
NPI:1699288167
Name:BULAONG, CATHERINE MANE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MANE
Last Name:BULAONG
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9245 LAGUNA SPRINGS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7991
Mailing Address - Country:US
Mailing Address - Phone:510-754-1485
Mailing Address - Fax:
Practice Address - Street 1:9245 LAGUNA SPRINGS DR STE 200
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7991
Practice Address - Country:US
Practice Address - Phone:510-754-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017223363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner